The clinical utility and reliability of surface electromyography in individuals with chronic low back pain: A systematic review

Chronic low back pain (CLBP) is a common disorder worldwide, affecting young and old adults alike. Kinematic studies of lumbar-pelvic mobility allied with surface electromyogram (sEMG) can assist in the assessment and management of CLBP. This systematic review aimed to synthesise the evidence relating to the diagnostic accuracy and reliability of the surface electromyogram in chronic low back pain patients during flexion-extension-relaxation tasks. Five databases (PubMed, Scopus, Web of Science, Embase and CINAHL) were searched for eligible studies from inception to March 2024. The risk of bias assessment for the included studies was conducted using the QUADAS-2 tool. Studies included adults (≥18 years) with CLBP > 3 months, reported diagnostic accuracy or reliability measures for sEMG during flexion-extension-relaxation tasks. Eleven studies were included in our systematic review. The risk of bias was found to be high for patient selection, reference standard and flow and timing domains with low risk of bias for the index test domain in most of the included studies. For diagnostic accuracy, six studies reported values ranging between 56-99 % indicating poor to excellent accuracy levels. Four studies reported values between 76-100 % for sensitivity and 65-100 % for specificity indicating sufficient to excellent accuracy levels. Seven studies reported moderate to excellent reliability levels, ranging between 0.66-0.99. This systematic review found the diagnostic accuracy and reliability of sEMG in CLBP patients to range from poor to excellent levels. This systematic review adds knowledge for practitioners and clinicians regarding the use of sEMG during forward, flexion and relaxation tasks/movements.